A personal story leads to a local solution in Torbay and South Devon

Lloyd Bettell-HigginsCase Study

In 2011, Gary Hotine, Health Informatics Service Director, at Torbay and South Devon NHS Foundation Trust (TSDFT), contacted Patients Know Best (PKB) looking for a solution to join up communication between healthcare services and patients or carers.

However, unlike others, Gary’s story was personal and as he said: “it was a family problem that led me to discover and use PKB.” Gary’s son suffers from a chronic health condition which resulted in regular visits to the GP and hospital. One Friday evening, Gary had to take his son to the accident and emergency department. He said: “I knew the pattern; he would be admitted and would have to wait until a clinical nurse specialist would see him on the following Monday to assess and discharge him.

“As part of his care we were seen in several hospitals and I knew that an asynchronous communication method would be ideal to coordinate his care and keep teams up to date. Building this system in-house for one hospital wouldn’t make sense as multiple organisations were involved in his care. I looked around the market in the NHS, asked various national bodies and didn’t find anything at first but eventually, I was put in touch with Mohammad at PKB via NHS Direct’s Business Development Manager.”

Explaining the requirements

Gary and the team at TSDFT were clear about their requirements from the outset. They were looking for a data sharing solution that supported strong information governance considerations, with a robust technical architecture that provided security, yet allowed flexibility and scalability.
He said: “I called and described to Mohammad what I was looking for. He was able to confirm that PKB was probably an 80% fit with what I wanted. Key aspects were that Patients Know Best is a secure system hosted within the N3 network, and included the ability to secure message across multiple clinical teams over multiple NHS organisations. Nothing else out there could do this.”

TSDFT soon trialled PKB within the Speech and Language Therapy (SA LT) team in Torbay Hospital. SALT had been looking for a way to conduct remote consultations with their patients using Skype but were finding it difficult to overcome the information governance considerations. Gary said: “PKB solved these issues so we started our first rollout.”

Education leads to engagement

There are a number of visionar y and passionate changemakers working hard to spread the adoption of PKB in TSDFT but this has not come without its challenges. As a user of PKB himself, Gary said: “One of the key lessons for us has been how important it is to have clinical buy-in and engagement to embed the technology in each speciality. We have a number of specialities who have signed up due to the vision of a single, committed team member. Some of these have remained active and others did not progress to become embedded in the service, but there has been great effort put into learning the lessons from these.

Overcoming barriers

Gary added: “Since we started working with PKB, the technology has improved greatly. However, what has remained constant is the dedication to offer a service along with that technology – and to listen to the users in the NHS as well as patients and adapt to their needs. The staff and ethos of the company are more important than the technology: the former is largely set, whilst the latter evolves over time.”

“A barrier to the speed of delivery was the manual, staff-led process of patient invitation. In the physiotherapy specialty, we allow self-registration for appointments which has proved popular since its inception, with all served GP practices informing their patients of the service and over 100 taking up the option each week. Next, we integrated with our hybrid mail solution to allow automated (and NHS number linked) record creation, with postal invitations sent to the patient’s homes. Importantly, this development gives cash-releasing savings that offset the cost of the PKB service to the Trust by replacing subsequently posted letters with an electronic equivalent in PKB.”

Torbay and South Devon Foundation Trust was first to trial postal invitations – 25% of patients registered immediately releasing savings for the trust.

Looking to the future

With TSDFT set to fully roll-out across the Trust, allowing all 350,000 local patients and 100,000 from out of area to access their records and receive letters online, Torbay and South Devon Foundation Trust are on target for their vision to create a paperless NHS and achieve big savings, and also be the first to trial PKB’s ‘read receipt’ API technology, allowing cash savings to be realised from reduced postal costs.

Gary added: “We now have a tested model that can bring records to the people of Torbay and South Devon, achieving a paperless vision and empowering and enabling patients and their care teams too. With 15 teams live, we are identifying new and novel ways of improving services through the use of PKB and aim to offer all patients access to their records in this way. In 2018, we integrated with one of the largest local GP practice groups in the area. This integrated digital care record allows the access of both primary and acute data to care teams whenever and wherever they need it.

“The additional focus on the patient that PKB brings, means that the patients involved are some of the very first in the UK to have patient-controlled access to a shared care record. Across Devon, there is a movement to break down the organisational boundaries and share records, and we are proud to be leading the way and bringing the patient with us on this journey in Torbay and South Devon.”